The goal of this project is to provide a better understanding of the relationship between dental care coverage and dental use among the elderly and subsequently provide the information needed to assist policy makers as they consider the inclusion of dental coverage under Medicare, Medigap and Medicaid plans or as an extension of post-retirement coverage within the private sector. This project is a collaborative effort of a multidisciplinary research team and will be conducted using data available from the Institute for Social Research (ISR) at the University of Michigan and The RAND Corporation. Specifically this project will: 1. Estimate the number and characteristics of those persons age 51 years and above who stay covered by dental insurance after retirement, stay uninsured after retirement, lose coverage after retirement, or gain coverage after retirement. The working hypothesis for this specific aim is that persons are less likely to have dental care coverage after retirement. 2. Estimate dental care use as a function of dental care coverage status and transitions controlling for individual and household characteristics and adverse selection. The working hypothesis for this specific aim is that persons are less likely to have a dental visit without dental care coverage. 3a. Estimate dental care out-of pocket expenditures as a function of dental care coverage and retirement status and transitions controlling for individual and household characteristics and adverse selection. The working hypothesis for this specific aim is that persons with a dental visit who are retired and/or without dental coverage will have higher out-of-pocket expenditures. 3b. Estimate changes in dental care out-of-pocket expenditures as a function of dental care coverage and retirement transitions controlling for individual and household characteristics and adverse selection. The working hypothesis for this specific aim is that persons with a dental visit who become retired and/or without dental coverage will have higher out-of-pocket expenditures. 4. Estimate the relationships between dental care use, coverage, and out-of-pocket payments and net wealth status and transitions, controlling for individual and household characteristics and adverse selection. The working hypothesis is that lower levels of, and reductions in, net wealth are associated with less dental care utilization and coverage, and higher out-of-pocket payments for those using dental care. 5. Estimate dental care use by dental procedure type as a function of oral health and dental care coverage status controlling for individual and household characteristics and adverse selection. The working hypothesis for this specific aim is that dental coverage induces regular preventive dental care, improves oral health, and lessens the need for expensive non-preventive procedures. 6. Estimate the number and characteristics of persons age 51 years and above reporting dental care coverage with atypically low levels of dental use and/or atypically high levels of out of pocket expenditures for those with dental use. The working hypothesis for this specific aim is that these groups are more likely to expect that dental coverage is included in Medicare and as a consequence mis-report having dental coverage. Results of this project will assist policy makers in the formulation of governmental policies, including a proposed extension of Medicare to include dental coverage, inclusion of dental coverage under Medigap plans, inclusion of full adult dental care coverage in Medicaid and an extension of post-retirement continuation coverage to include dental coverage within the private sector.

Public Health Relevance

The goal of this project is to provide a better understanding of the relationship between dental care coverage and dental use among the elderly and subsequently provide the information needed to assist policy makers as they consider the inclusion of dental coverage under Medicare, Medigap and Medicaid plans or as an extension of post-retirement coverage within the private sector.